Twitter is a free social networking and micro blogging service that enables its users to read and send text-based posts of up to 140 characters, called tweets. The network of contacts is a system which allows you to follow users (following) and be followed by other users (followers) without requiring authorization.

Messages are automatically published on the users’ front page (timeline).

Any user may answer (reply) or forward (retweet) any tweet, in this way generating public debate and conversation. In addition, links can be added to the tweets in order to give additional information beyond the 140 characters.

Some key aspects which may help us to understand the potential of Twitter.

Multifocal. Twitter is a window to unlimited sources of information. In fact, the amount of information circulating on this network is huge (more than 200 million tweets per day).4 So much so that there is a danger of what has already been dubbed “infoxication”.5 However, Twitter offers the possibility of creating lists to manage tweets by themes or authors and tags (hashtags) which also helps manage the information by making it easier to follow a particular topic.

Moreover, social media aggregators (e.g. TweetDeck, Hootsuite…) have emerged to manage content from multiple social networks services.

Immediacy. Twitter is a very effective source of information. Update is instantaneous, which makes it an ideal tool to disseminate information or to broadcast live events (conferences, information on public transport, or any event worldwide6). Twitter is fast and viral (anyone can forward a tweet) so that the spread of information is unstoppable.

Links. One of the characteristic features of Twitter is its ability to include links that makes it easier to move from one content to another (user names, references, links that are added to tweets, hashtags…).

Ubiquitous/mobile. As with any social network, Twitter can be accessed anytime and anywhere, a fact that has been enhanced by smart phones. This facilitates the broadcasting of live events by users themselves, a valuable tool from the point of view of peer-to-peer communication.

Twitter is part of the new wave of the global transformation of information and communication, called Social News.7 This introduces the idea that the future of communication between people is based on obtaining information directly from the original source. Social media and web 2.0 enable users to become prosumers,8 that is consumers and also producers of content on the web.

Twitter is an example of a growing trend called Personal Learning Networks, by which people can learn through a selection of experts (personal network) about a particular topic or subject area.

Twitter is an effective tool for information dissemination but it can be used for many different purposes. In fact, it has been massively adopted in many sectors including healthcare. Let's look at some examples of how useful it can be, focusing on four main areas: 1) Access to generic and scientific information, 2) Contact with the professional community, 3) Public health, 4) Relationship with patients.

People frequently try to make a simplistic assessment of the impact of a tool based on the number of followers or subscribers and it is true that numbers can shed light on social impact. However, Avinash Kaushik, in his blog,26 has proposed a method of assessing the impact of social networks that allows us to get away from the merely quantitative (number of followers or subscribers, number of comments, number of tweets…). The three elements of measurement are the “conversation”, the “amplification” and the “applause”. From these concepts come three rates:

• 1.

  Conversation rate: if the goal is to engage a lot of people, one parameter would be a good conversation rate which is measured through the number of mentions or retweets.

• 2.

  Amplification rate: if we want to measure how much content is shared, then we have to combine the measure of retweets with the size of the retweeters network.

• 3.

  Applause rate: number of positive reactions in relation to a post or a tweet.

This approach allows us to reinforce three possible uses of Twitter: to converse (many people talking about one topic/user), to distribute or amplify (many distribute what you have produced) or to assess the attitudes to a proposal (applause).

There are certain risks associated with participation in social networks. Clearly one of the challenges posed by the information society is to manage the huge volume of information circulating on the Internet.

Twitter can play a role in information management. It allows us to identify users (individuals, institutions, magazines) who can act as our information filter (a social filter). Through them, we can directly access the most relevant information to our field of interest.

Additionally, you can use hashtags or communication feeds to classify tweets by theme, or do something as simple as stop following users when they do not add value.

On the other hand, there are risks associated with privacy issues. We are faced with an ethical dilemma about the potential of the Internet and social networks to challenge the traditional boundaries of the doctor–patient relationship.

Some studies have warned that doctors may be unwittingly exposed to risks when they employ these for personal use.27 In response, professional associations around the world are drawing up public guidelines or making recommendations for the proper use of social networking.28 There are no rules and, sometimes professional or positioning statements regarding doctors’ criteria for using these tools with their patients may be sufficient.29

Like most 2.0 tools, learning is about starting to use them. It makes no sense to pay much attention to a tool that is not going to be used regularly.

The best way to get introduced to the world of Twitter is with the counselling and support of someone you trust. Twitter has its own language and even though some guides with “basic terminology” may be useful (Table 2), our recommendation is to start by observing how it works (before starting tweeting).

At the beginning, it is worth following a small number of professionals who use Twitter “moderately” (more than four or five tweets per day are difficult to follow). Followings of professionals should be complemented by looking at other users such as institutions and specialized journals. Do not hesitate to stop following users who give no added value. There are thousands of really interesting voices out there!

The conversation is there…what are you waiting for? Go and find it, it is worth doing it. Get connected!

The authors have no conflicts of interest to declare.